Provider Demographics
NPI:1184736126
Name:ALLEGHANY MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:ALLEGHANY MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JORGE
Authorized Official - Last Name:GORDINHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-254-9022
Mailing Address - Street 1:2962 ROBERT C. BYRD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-254-9022
Mailing Address - Fax:304-254-9024
Practice Address - Street 1:2962 ROBERT C. BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-254-9022
Practice Address - Fax:304-254-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
WV261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCK7027OtherRAILROAD MEDICARE
WV3810006041Medicaid
WVP00177367OtherRAILROAD MEDICARE
WV0072202000Medicaid
WV3810006041Medicaid
WVNP21791Medicare PIN
WV9319761Medicare PIN